I was a full-time staff writer here at Forbes for eight years covering health care.Now I work in hospital administration. I am originally from Pittsburgh but have lived in New York, San Francisco and Philadelphia. I have a bachelors degree in economics from Harvard and a masters in health administration from the University of Iowa.

Dr. Berwick, a pediatrician by training, was a major get for the Administration. A Harvard professor, he founded the Institute for Healthcare Improvement, a think tank that trains hospitals on how to increase patient safety and improve operations. When the President picked him to run Medicare, it seemed like an obvious and perfect choice.

The problem was his worldview. His approach to health reform, like the President’s, promotes centralizing health care delivery and using government programs to force change. (Not surprising, given that he was the President’s nominee, right?)

But once Congressional adversaries got a hold of some of Berwick’s old writings, in which he had said nice things about the National Health Service in England, he became the subject of an ideological confirmation battle. The President countered by giving him a recess appointment, which meant he would only be able to serve until the end of this year–unless he was re-confirmed through Congress. Once it became clear that the President wasn’t willing to stick his neck out, Berwick left. You can’t blame him.

One insider I spoke to said Berwick knew he would have to leave, but stuck around this long to start the Partnership for Patients, a $1 billion program that funds research in his old area of work.

But to me, even as someone who’s been skeptical of the ObamaCare approach to reform, the Berwick resignation is part of a troubling pattern where engaged, interesting thinkers get booted out of positions of power.

Nomination fights have blocked left-leaning intellectuals like Lani Guinier and more recently Goodwin Liu. On the right, Robert Bork and Michelle Rhee were squelched based on having radically interesting ideas. If you’re an intellectual spark plug, politicians rush to defuse you.

So what do you get instead? Look around DC at all the bland bureaucrats who are great strivers and over-achievers. The problem is that all their work has the same flavor: vanilla. I’d argue instead for appointing quality thinkers like Berwick and then letting them succeed or fail.

Right now misguided ideologues are criticizing the nomination of Henry Aaron, a well-respected economist, to the lowly Social Security Board. Had these same activists even heard that such a board existed before joining the latest anti-intellectual lynch mob?

Our current President spent years as a State Senator abstaining from controversial votes. He spent years before that teaching Constitutional Law at one of the country’s best law schools but he never wrote a anything interesting. Unlike Berwick and others who have been Borked over the years, Obama must have known the game.

Like Berwick’s ideas or not–his resignation is a pity.

UPDATE November 27Berwick’s replacement, Marilyn Tavenner, is profiled here by Sarah Kliff of the Washington Post. She’s a nurse turned hospital administrator who worked at the for-profit system HCA, where she rose to become a star before leaving to run the state of Virginia’s health department. Kliff calls her a pragmatist. (Unlike Berwick, who’s more of an idealist, I suppose.)

Ironically, one of Berwick’s early mentors was Paul Batalden. He was a powerful HCA executive who once played host to a young Donald Berwick. Batalden was hired by HCA founder Tommy Frist and led quality improvement initiatives across the system.

Berwick, who was then working for the Harvard Pilgrim health plan, spent time with Batalden–a pediatrician by training who previously ran the Park Nicollet medical practice in the Twin Cities–to learn about how HCA had improved important quality metrics like length-of-stay and orthopedic surgery infection rate and recovery times. Batalden left HCA after the Columbia merger, which degraded the culture of the company. Later Batalden joined Dartmouth where he still teaches health leadership.

For more on this intellectual history of the quality movement, read Michael Millenson’s terrific book Demanding Medical Excellence. One takeaway: The world of health quality research and hospital administration is a small one.

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As a senior physician commenting on Dr. Berwick, another senior physicianI can only say that, though he is a decent fellow, clearly intelligent and motivated by ideals, he had two flaws that make it a blessing that he has resigned:

First of all, his motivations for patient safety are flawed due to the driving force of his personal tragedy. Every ethical physician, and that includes the great majority of us, wants maximum safety. We do not need being harangued by ever more complex protocols generated by faceless distant persons with no skin in the game, for us to seek this. Unfortunately, Dr. Berwick’s being enamored of centralized, complex, computer driven, over controlling systems for achieving safety, has cost billions, has ground efficiency to a halt, has skyrocketed cost. The solution became so complex that it literally caused the problems it was designed to cure.

Secondly, medicine is, has been, and will be, imprecise. People are not identical, nor are they equally driven to the same goals. By leaving the patient out of these equations, Dr. Berwick has left the greatest variable untouched and made the problem of insuring safety impossible for those of us left holding the bag.

Sorry, Don. You are a decent human being. But healthcare is better for your not being in the driver’s seat. None of this is meant to infer that the GOP driven nonsense of perpetuating Big Insurance, Big Pharma and Big Institution as the final arbiters of healthcare, is a good thing. It is not. The problem remains that centralization, whether government or business oriented, is bad for an industry that is intensely personal, and just as intensely variable and as fuzzy as each individual patient. It cannot be otherwise. Don’t pay for what the patient really needs and pay for what enriches Big Business? You will get wealthy big business and not get what patients really need from their doctors. But the big boys can really make a bundle if they can keep bamboozling the populace and keep the doctors off balance and defensive about “prior authorization”, “not medically necessary”, “HIPAA violations”, “patient safety protocols” and the like.

It is complex. These situations always are. And Dr. Berwick’s solution is not one. Happy retirement.